Bariatric Breatkthroughs

One of the most popular movies this summer was a little documentary about a big subject. "Super Size Me" follows the (mis)adventures of a thirtysomething named Morgan Spurlock, who ate nothing but selections from the McDonald's fast food menu for an entire month. What Spurlock gains from this experiment is, of course, a lot of weight. But more importantly, "Super Size Me" goes behind the famous Golden Arches to discuss a bigger issue — why so many Americans (more than 60 percent) are obese or overweight. When, as the film reports, the most commonly eaten vegetable in America is french fries and one in every three children born in the year 2000 will develop diabetes in their lifetime, it's clear that something's wrong.

The movie's title comes from the nutritionally harmful trend of super-sizing food portions...more cheese, bigger hamburger patties, and seemingly bottomless 64-ounce soft drinks are commonplace these days. And, believe it or not, super-sizing extends well beyond the world of dining out.

You might notice that not only have car and airplane seats gotten bigger, but so have clothing sizes: in 1966, the measurements for a woman's size 10, in inches, were 31-24-33. In 1972, they were 32.5-25-34.5. Today, they're 36.5-28-38.5.

Meanwhile, chances are your clients are getting bigger. Obesity can have quite an impact on a person's mobility, and many of the devices you provide are steadily getting bigger, heavier and wider.

A Big ImpactThese days, nearly every major mobility manufacturer has a bariatrics division. Some companies like Gendron, Inc., Wheelchairs of Kansas, and ConvaQuip even specialize in this increasingly vital niche.

Just how crucial is the need for so many products dedicated to clients weighing upwards of 350 lbs? John Lescher, group product manager of personal care, beds and bariatrics for Invacare Corp., says weight standards within the mobility industry have clearly changed. "Years ago, the standard was around 200 or 250 lbs.," says Lescher. "Right now, the standard capacity is more like 300 lbs."

Sunrise Medical's Tim Berry says, "Standard weight capacities across the board are increasing. The starting point for bariatrics seems to be 500 lbs., but it is creeping upwards to 1,000 lbs. It used to be that specialized dealers offered [bariatric] products. Now it seems like all dealers want or need bariatric products in their showroom/product line-up."

Gendron, Inc.'s Steven Cotter has also observed this shift toward larger, sturdier mobility devices. "From our perspective, 'standard' has become at least 350 lbs.," he says. "Five years ago, we offered three seat widths up to 24" wide, and two weight capacities. Today, we offer wheelchairs with seat widths from 20" to 32" — custom chairs offer infinite choices — and weight capacities from 350 to 850 lbs. And these are standard production products.?

With that sense of normalcy, it's no wonder there are so many products boasting weight capacities of 600 lbs. or more. According to Lescher, "One of the things that I've observed is an increased request for larger weight capacities, and wider, deeper products — for example, shower chairs with wider and deeper seating surface areas? We are facing an epidemic with overweight and obese populations. I'm amazed by some of the statistics. The majority of our providers are selling some form of bariatric product today."

Increasing AwarenessHeightened awareness of the nation's obesity epidemic, says Quantum Rehab's Scott Higley, has caused an increase in the number of bariatric products in the mobility marketplace. "As a whole, bariatrics has long been an ignored market," says Higley. "It was a niche that a lot of people didn't focus on?But I think the demand for bariatrics has increased because awareness has increased."

While the bariatrics segment of HME is a profitable one, Lescher says the numbers might be encouraging for sales, but not for the nation's overall health. "[Invacare's] approach is not just product-oriented. We are committed to providing solutions that are focused on improving the quality of life for the consumer," Lescher says. "We're looking at ways to educate providers, clinicians and consumers about this epidemic. We want to promote wellness programs, and that [overweight and obese] people don't need to be this way for the rest of their lives. Even if someone is 400-500 lbs., losing 50-100 lbs. can make a huge difference in their lives."

Likewise, says Higley, "[Quantum Rehab's] focus is not just on durability, but in adding style and maneuverability to these bariatric products. We want to meet the functional needs of every client, while also increasing access to their world by minimizing [a vehicle's] bulkiness and making sure they can use it indoors and outdoors?These clients can still be active."

Enabling IndependenceThe goal of any mobility product is to get a client moving. When that client is obese, that strategy does not change, even if the stereotype of an overweight individual might be that of a lazy, unmotivated person. Along with the wealth of news reports and books on obesity, there has been a lot of talk about how to conquer this epidemic through lifestyle changes. So for many of your obese clients, a wheelchair or walker might function as a means to moving them forward, in more ways than one.

"As treatments for the [bariatric] patient emerge, the patient requires a greater range of mobility and assistive devices," says Cotter. "The goal is to mobilize the patient very quickly, and this creates a need for a variety of products to enable the patient to be independent."

In other words, by providing an obese client with a mobility device, you might be helping that person on his way toward achieving a healthy, active lifestyle. More and more, bariatric products and the manufacturers who market them are emphasizing activity over function.

Rob Piekarczyk, Invacare's associate product manager for consumer power, describes the manufacturer's new Pronto M94: "This vehicle goes up to a 500-lb. weight capacity. We've kept the same base footprint of the M91, and this allows the chair to get through tighter spaces and be used realistically indoors?It's a package that takes a couple of features that weren't able to be joined before and provides a higher weight capacity at the same time."

Says Piekarczyk, "We realize that these individuals enjoy freedom and mobility and that an active lifestyle is a part of the road back to wellness. We've taken the approach of educating and helping the bariatric population into a healthier lifestyle. New products, such as the Pronto M94, will continue to be developed that will give bariatric clinicians and consumers alike the opportunity to prevent the obesity epidemic from spreading further."

Higley describes Quantum's latest bariatric product, the 1650, as a power chair with more than just a 650-lb. weight capacity. "It's designed to give users a new level of independence. This chair offers style, mid-wheel-drive capabilities and maneuverability to the bariatric client and meets higherend rehab needs with a bariatric tilt system."

The Access ParadoxOne of the challenges inherent with bariatric equipment and the clients it serves, however, involves access. Says National Seating & Mobility's Stephanie Tanguay (OTR/ATP/CRTS), "There are times when I really have to make decisions based on someone being independently mobile in the community, but [the bariatric equipment] doesn't necessarily allow them to access public or even van transportation. A lot of times, bariatric equipment is so wide; you can't accommodate it on a lift. The standard, even the high-end, lifts have an 800-lb. weight capacity. If a chair accommodates someone who's 500-600 lbs., that chair — without anyone sitting in it — will be well over 500 lbs. So it might allow someone independence in the community, but that person can't even get to a doctor's appointment."

Tanguay, whose office handles about 20-30 bariatric clients, sees other physical dilemmas that equipment alone can?t seem to solve. "There's a nice variety of durable, adjustable bariatric products available that didn't used to be out there. But once you've accommodated weight and the appropriate width for a person's hips, for clients to still be able to reach over and access the wheels and push that weight is very difficult. The extra weight seems to make propelling more destructive over time to the shoulder joints."

The solution? "This is definitely a population that could benefit from having both a manual and a power chair," says Tanguay. Breaking it Down Misconceptions also abound about who, in fact, qualifies for bariatric equipment. Your seemingly "average" clients might be surprised to hear the words "heavy-duty equipment," even though, as Tanguay points out, more people qualify for bariatric products than ever these days. "Everyone always thinks obesity is related to excessive intake of food, but that's really not the case. There are definitely people who have a predisposition to obesity, and you don?t have to be that big of a person to qualify for bariatric equipment?You don't have to look too far to find men who are between 6'1" and 6'4" and weigh in excess of 250 lbs. — even that would put them out of the range to qualify for a standard rehab chair. You'd have to put them into a heavy-duty manual chair. They wouldn't necessarily think of themselves as obese or bariatric, but for an adult male in this country to be 6'3" and 260 lbs. is not uncommon."

Bariatric Facts

On July 15, 2004, a new Medicare coverage policy was announced, stating that obesity is an illness. This will allow clients to request that Medicare review medical evidence to determine whether treatments related to obesity would be covered by Medicare.

More women than men are affected (approximately 35% vs. 30-31%); obesity occurrence doubles in low socio-economic areas, rural areas, and in people with lower levels of education.

Obesity is the second leading and most preventable cause of death after smoking in this country.

The term "bariatrics" does not mean "obese" or "overweight" — rather, it is the field of medicine that emphasizes treatment for people who are obese/overweight.

An informal survey of RTS's working for National Seating & Mobility showed more than half currently have clients weighing 350 lbs.-plus.

ABDOMINAL obesity, with weight mostly around the abdomen, will affect depth of seat and how to distribute and balance the weight in the chair for safety and comfort (not too far forward or back). Also, when wide hips require a wide cushion/seat, the user may have problems self-propelling, because arms will not effectively reach the pushrims.

EXTRAGENOUS obesity is caused by excessive food intake and failure to burn it off. People unfamiliar with bariatric clients usually assume this to be the cause of most/all obesity problems, but that?s not true.

GLUTEAL FEMORAL obesity, with weight distribution in the rear end and thighs, can cause problems with self-propulsion (can't reach pushrims due to width of seat) and can require special consideration for leg rests. May not be a good candidate for foot propulsion because weight in legs may decrease mobility.

HYPOTHALAMIC obesity is caused by a problem with the hypothalamus.

MORBID obesity is used to describe obesity that is severe enough to interfere with normal daily activities, including respiration.